Reflections on Vienna: AIDS 2010

As I departed Los Angeles for the International AIDS Conference in Vienna, Austria, millions of gallons of oil were spewing into the gulf. I cannot remember when I felt like I was witnessing something beyond everyone's control and it angered me that our greed and lack of forethought as a nation, had led to an environmental disaster of this magnitude. It was not that I really needed an excuse to get out of the US, but this particular situation had me feeling helpless and depressed for weeks, so the opportunity for change was a welcome one.

While the conference officially began on Sunday, July 18 with proceedings for a week, the kick-off was Saturday night's "Life Ball", the largest AIDS charity event in Europe. The "Life Ball" brings everyone out onto the streets of Vienna in front of the town hall and into the surrounding park where all can view the event on giant screens. It is an incredible way to mark the kickoff of the international AIDS conference and it was wonderful to see the event being celebrated by families and children of all ages. I wondered if the same sort of celebration could ever happen in the US.

This year marks the 2010 deadline for universal access set by world leaders, and so the push for expanded access to HIV care, prevention and treatment has never been greater. With a global economic crisis looming in the background, this year's conference emphasized the importance of keeping HIV/AIDS in the forefront of the discussion of broader health and development goals. AIDS 2010 also reiterated the important connection between human rights and HIV, a theme stemming from the last International AIDS Conference of 2008 in Mexico City. Vienna delegates were to assess the progress that has been made toward that end, and determine the next steps to be taken individually and collectively to achieve our goals and move forward.

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With an estimated 19,300 participants from 193 countries and more than 2000 media present at this conference, Vienna was getting lots of global attention. I found it to be a very clean and beautiful city with old-world charm, and a very efficient subway and tram system. Vienna was also chosen for its location in the middle of Europe, providing a bridge between eastern and western Europe, with eastern Europe experiencing one of the fastest growing epidemics, primarily stemming from injection drug use. An official declaration from the conference, something that has only happened once before, called for incorporating evidence-based practices into illicit drug policies (www.viennadeclaration.com). The 2010 theme "Rights Here, Rights Now" was seen as a call to action to promote and protect human rights as a requirement for a successful response to the HIV/AIDS epidemic. In response to high HIV prevalence rates among men seeking men (MSM) around the world, global health leaders called for an end to human rights abuses against MSM that contribute to HIV vulnerability. At the opening plenary session, UNAIDS Executive Director, Michael Sidibe, addressed such abuses very clearly when he said, "our vision of zero AIDS will never see the light unless we end criminalization of people by their sexual orientation." Yves Souteyrand from the World Health Organization (WHO) framed the entire proceedings with some daunting statistics. The global prevalence of HIV is on the increase and now stands at 0.8% with the number of people living with this disease rising daily as a result of global population growth, continued transmission, and fewer deaths as a result of antiretroviral therapy. Each day an estimated 7400 infections, 1200 in children; 5000 people die of HIV/AIDS daily and 3000 begin antiretroviral therapy. Therefore, the HIV/AIDS epidemic is outpacing treatment and prevention efforts.

Treatment and prevention efforts continue to be paramount in the fight against HIV/AIDS, however, and some very positive developments have taken place as a result. UNAIDS estimate that 200,000 HIV infections in children have been prevented in the past 12 years due to antiretroviral medications used for prevention of mother to child transmission. This number is expected to increase as there is expanded access to treatment. There are more than five million people currently on antiretroviral therapy in low and middle income countries, and as a result fewer AIDS related deaths. While prevention has had a great impact on new sexually transmitted diseases in countries where there is a higher prevalence, stigma, discrimination, and human rights violations remain the greatest barrier for many others. Even in affluent countries like Canada, where many treatments are accessible without cost, people are becoming infected with HIV and getting sick without linkage to treatment as a result of stigma and discrimination.

Both Bill Clinton and Bill Gates addressed the conference in plenary sessions on the first day and emphasized the importance of improving the efficiency of delivery and scale-up of HIV prevention in their addresses. Bill Gates emphasized that known effective strategies for HIV prevention, including antiretroviral treatment and male circumcision, had to be delivered more effectively and efficiently to populations at risk; moreover, that new potential strategies for prevention such as antiretroviral-based prevention strategies like microbicides and pre-exposure prophylaxis needed to be implemented rapidly and efficiently once efficacy studies were completed. He presented results of a preliminary mathematical model that suggested that current and new tools for prevention could cut new infections by 90% in the next 20 years. Bill Clinton also stressed the need for better systems of delivery and additional funding now. He emphasized that investing now rather than later would have an effect on our entire global economic infrastructure. His Clinton HIV/AIDS Initiative (CHAI) through his foundation works with governments and corporate partners to expand treatment access in developing countries where more than 90% of people living with HIV/ AIDS reside. Among other things, the Clinton global initiative has assisted in getting 5.2 million people on treatment, strengthening health care delivery systems to fight malaria and tuberculosis, negotiating a price reduction for generic medicine, and getting a hand-held device to rural villagers that determines baseline health status (i.e., CD4 count).

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